Monday, May 27, 2013

What is Psychosomatic Medicine?

Update: Starting in 2018 Psychosomatic Medicine subspecialty is now called Consultation-Liaison Psychiatry.

Recently a doctor friend of mine asked me, "What is psychosomatic medicine?" When my answer was more vague than concrete, I realized clarification was in order.

Psychosomatic Medicine is a subspecialty of psychiatry. The American Board of Psychiatry and Neurology gives the following definition:

Subspecialization in the diagnosis and treatment of psychiatric disorders and symptoms in complex medically ill patients. This subspecialty includes treatment of patients with acute or chronic medical, neurological, obstetrical or surgical illness in which psychiatric illness is affecting their medical care and/or quality of life such as HIV infection, organ transplantation, heart disease, renal failure, cancer, stroke, traumatic brain injury, high risk pregnancy and COPD, among others. Patients also may be those who have a psychiatric disorder that is the direct consequence of a primary medical condition, or somatoform disorder or psychological factors affecting a general medical condition. Psychiatrists specializing in Psychosomatic Medicine provide consultation-liaison service in general medical hospitals, attend on medical psychiatry inpatient units, and provide collaborative care in primary care and other outpatient settings

I glazed over just trying to type this out. In a nutshell it's medical psychiatry: the interaction of the mind and body in relation to the onset, process and progression of all diseases. It's understanding and practicing a healthy mind, healthy environment and healthy personality mean physical health, mental health and well being. It is a holistic concept of disease management leading to mind and body wellness. I literally assess the psychological, neurological, endocrine and immune status of the individual. I assess the medical disease status of the individual. I understand personality, genetic and environmental factors that affect homeostasis or wellness. I evaluate and can improve patient function mentally and physically using evidence based medical treatment and psychotherapy techniques. The approach is integrative where the bio, medical, psycho and social aspects of wellness are considered. Psychosomatic medicine is the new field of integrative medicine.

As you can see the total person is evaluated; psychosomatic
medicine subspecialists leave nothing on the table.
Total health and well being is where the 3 circles intersect.

I spend most of my time with the above evaluations particularly in chronic pain management and addiction medicine. I am able to improve mental function and outcomes in the setting of medical complications such as drug withdrawal and detoxification. My treatments are aimed at achieving wellness without relapse. I minimize polypharmacy and lifelong medication use. Polypharmacy and lifelong medication is antithetical to the definition of psychosomatic medicine.

I know this definition seems long. One of my teenage patients said just call yourself an uber psychiatrist. I think I like that!

Friday, May 17, 2013

Narcotic Abuse, Dependence and Treatment

Currently in the United States, 7 million people are addicted or physically dependent to some form of opiate or prescription pain killer. Substance abuse disorders are at epidemic proportions. In my practice, I have seen many patients suffer with various addictions and/or other mental illnesses. Often these disorders are not adequately treated at rehabilitation and sober living programs where you can spend thousands of dollars to get well for 30 days; only to leave and relapse. Not only is this a waste of time and money but the experience of more failure leads to depression and anxiety aggravating more substance abuse.

A recent study, The National Center of Addiction and Substance Abuse at Colombia University, highlights the lack of care that most American’s who seek this treatment experience. It’s not enough to detox, treatment should focus on relapse prevention. Usually this should be done in the context of an outpatient office or clinic where patients not only learn to function in their environment but also thrive. Leaving a sober living in Malibu and going back home with a few skills learned over 30 days, almost always ends in relapse.

In my office as a psychiatrist, I am able to address all aspects of substance abuse including detox as well as managing other problems like anxiety, depression, mood disorders or other mental illnesses which cause people to use drugs in the first place. It is a rare person who uses and abuses narcotics in a vacuum. Most people who are suffering dependency issues are usually drug abusing in an attempt to self medicate these underlying disorders. Detoxification from all substances is usually the starting point. If there has been a history of relapse in the past, maintenance treatment is often discussed. These highly individualized treatment plans include Suboxone/buprenorphine to achieve full functioning in all aspects of your life. Usually when this goal has been attained, further sobriety and prevention of relapse can continue where medications like Vivitrol/naltrexone injectable and psychosocial support, including psychotherapy, are arranged. An essential focus of the treatment plan at this point is also treating any underlying illnesses like depression or anxiety and any debilitating symptoms like insomnia, pain, restlessness or difficulty with attention. Most rehabilitation centers or physicians who do this kind of treatment are unable to provide all these aspects of care.

Setting an appointment is easy where the initial evaluation is an hour long with weekly treatment thereafter for the first 30 days. Other collateral treatment modalities are utilized including psychotherapy, drug testing, supportive groups, meditation, yoga, or anything else that promotes your wellness. Arrangements with other health care providers and medication assistance is usually for a period of 6 months or more with continued monthly psychiatric visits. In addition to saving money, patients can get well in the quickest and easiest way possible.

If you're suffering with narcotic dependency, know that there is help that is effective and simple. You are not a drug addict. Addiction is treatable.